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General NPI Number Information
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NPI Number | 1982961603
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Entity Type | Organization
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Legal Business Name | RENEWAL COMPREHENSIVE SERVICES, LLC
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 5950 E LINCOLN AVE STE 300
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City | LISLE
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State | IL
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Zip | 60532-3387
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Country | US
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Telephone | 312-399-3077
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 W BOUGHTON RD # 166
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1508
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Country | US
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Telephone | 312-399-3077
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. LESLIE LEWIS FORD
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Credential | PH.D., LCSW
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Telephone | 312-399-3077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149011528
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License Number State | IL
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